One in four MRSA patients 'infected in community'

More than a quarter of hospital patients with MRSA could be picking up the superbug in the community, according to unpublished data.

University hospital Birmingham NHS trust found 28% of patients with MRSA had the infection before being admitted to hospital.

The local figures suggesting many patients are infected with MRSA before arriving at hospital are likely to provide ammunition to health service managers, who face the prospect of prosecution for patient MRSA deaths on their wards under new government plans.

Under the proposed legislation, NHS managers would face criminal prosecution for failing to strengthen hospital hygiene controls to combat MRSA.

They would not be charged with corporate manslaughter for the death of individual patients, but could be held criminally liable for ignoring improvement notices issued by NHS watchdog the Healthcare Commission.

Paul Hateley, nurse consultant in infection control at the trust, denied that the study was politically motivated to deflect the blame from the hospital for the rate of MRSA.

The findings are the first to calculate a figure for the level of MRSA acquired outside hospital after infection control staff decided to break down their MRSA blood infection data.

This followed an increase in the number of MRSA cases in the last quarter of this year, compared with the same period last year.

The patients in the Birmingham study who acquired MRSA before being admitted came from nursing homes, their own home, or had been transferred from another hospital.

Mr Hateley accepted that many of the affected patients may have had contact with hospitals in the last 12 months, but none of the patients in the study had left the trust with MRSA.

A significant number of patients discharged from hospital in the UK carry the MRSA bug but fail to develop the symptoms, Mr Hateley said.

"I cannot say they are not from here but I can say that patients would not have been discharged when they were brewing that because they would have symptoms," he said.

"We also took into account when they were last in hospital and all those [in the study] had been living comfortably in the community in a given period of time."

But a leading microbiologist scotched the notion that patients coming to hospital with MRSA had acquired it in the community.

Dr Stephanie Dancer, consultant microbiologist at Southern general hospital in Scotland, said those currently affected outside hospital were likely to have a hospital connection within the last 12 months where they had picked up the infection.

"I am not surprised by these figures," she said. "If you think about the patients that are coming through to hospital, most are elderly and the chances are that they are either coming from a nursing home or have been in hospital in the last 12 months."

Dr Dancer said MRSA rates were flourishing because of the "terrible conflict" between bed management and infection control in hospital.

New Department of Health figures published last week showed that MRSA rates rose in 40% of trusts in 2004-05, although there was a 6% drop overall.

But though Dr Dancer discounted community-acquired MRSA as a key source of infection now, she said this was likely to change in the future as microbes learn to adapt. "We are going to see more and more of the community strain MRSA," she said. "That is Darwinian evolution."

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